摘要：Objectives. We compared school nurse visit syndromic surveillance system data to emergency department (ED) visit data for monitoring illness in New York City schoolchildren. Methods. School nurse visit data recorded in an electronic health record system are used to conduct daily surveillance of influenza-like illness, fever–flu, allergy, asthma, diarrhea, and vomiting syndromes. We calculated correlation coefficients to compare the percentage of syndrome visits to the school nurse and ED for children aged 5 to 14 years, from September 2006 to June 2011. Results. Trends in influenza-like illness correlated significantly (correlation coefficient = 0.89; P < .001) and 72% of school signals occurred on days that ED signaled. Trends in allergy (correlation coefficient = 0.73; P < .001) and asthma (correlation coefficient = 0.56; P < .001) also correlated and school signals overlapped with ED signals on 95% and 51% of days, respectively. Substantial daily variation in diarrhea and vomiting visits limited our ability to make comparisons. Conclusions. Compared with ED syndromic surveillance, the school nurse system identified similar trends in influenza-like illness, allergy, and asthma syndromes. Public health practitioners without school-based surveillance may be able to use age-specific analyses of ED syndromic surveillance data to monitor illness in schoolchildren. School-based public health surveillance has historically been conducted indirectly by monitoring student absenteeism records. To be specific, school absenteeism data have long been used for influenza surveillance. 1,2 Since the emergence of pandemic H1N1 influenza A in spring 2009, there has been increasing interest in using school absenteeism data to monitor influenza-like illness (ILI) in school-age children 3–5 and to inform policy decisions regarding school closure. 6 If one assumes that absenteeism is a proxy for illness, these data can provide some valid information about the course of an influenza season or outbreak. However, school absenteeism data often lack the specificity to be useful, particularly for early outbreak detection. 7 There are many reasons why students are absent from school that are unrelated to illness and the specific reason for absence is usually not available. 8 New York City (NYC) has the largest system of public schools in the United States, serving about 1.1 million students in nearly 1700 schools. The NYC Department of Health and Mental Hygiene (DOHMH) has the unique opportunity to conduct health surveillance of its public-school population by using information collected electronically during school nurse encounters. School nurses provide on-site services full- or part-time to approximately 90% of elementary and intermediate public schools. Nurses record information about walk-in visits by using an electronic health record system. Data are transmitted daily to DOHMH and analyzed to monitor illness among schoolchildren. In addition, DOHMH conducts other syndromic surveillance of emergency department (ED) visits, ambulance dispatch calls, and pharmacy sales. 9
